Improving oral health in populations who do not easily access the private dental office or the available community care site is a challenge to dental hygienists and others concerned with the health and well-being of all. Partnerships for improved oral health have been part of the community health efforts for many years and in many countries. With the knowledge, skills, and resources that are held by specific groups and organisations combined into a larger entity of a partnership or coalition, greater impact on oral health issue may be possible. Agencies and individuals interested in making improvements in oral health status in any particular target group may begin a process of working with others who have an interest in improving the health and well being of that target group. In a world that is increasingly synergistic and mutually dependent, improvements in oral health can be advanced by considering the elements of successful coalition building and forming partnerships with multiple organisations and individuals.
BACKGROUND Fire is a leading cause of unintentional injuries among children in Canada. More specifically, residential fires are responsible for too many preventable deaths and injuries. Yet, there is no national database that reports on residential fire-related injuries and deaths among children. Although socio-economic determinants (SED) have been associated with increased risk of residential fire in the USA and UK, little is known about the significance of this impact on the Canadian child population. OBJECTIVES This study examined the role of SED (low education, median income and average number of persons per dwelling (ANPD)) in residential fire-related injuries and deaths, and assessed the relationship between age and the severity of residential fire-related injuries and deaths, among children and youth in Canada. DESIGN/METHODS A cross-sectional study design was used to examine data from the National Fire Information Database (NFID), which includes 10-years (2005–2015) of microdata information on fire incidents and losses reported by provincial/territorial Fire Marshals and Fire Commissioners Offices across Canada. Census 2011 data at the CSD level, from Statistics Canada, provided the SED variables. Our outcome of interest was the odds of death and major injury over minor injury. A logistic regression model was applied to test the relationship between age and SED with our outcome of interest, while adjusting for province. RESULTS For every 1 person increase in the average ANPD at the CSD level, there is a 31% decrease in the odds of dying or being severely injured in a residential fire (p=0.0003). For every 1% increase in CSD’s low education proportion, there is a 2.5% increase in the odds of dying or being severely injured in a residential fire (p=0.0002). Median income was not significantly associated with the odds of death and major injury over minor injury. The odds of death and major injury were not significantly different for youths and adults, compared to children, controlling for ANDP, low education and median income. CONCLUSION The National Fire Information Database is one of the first to amass reliable fire incident and loss information across Canada into one database. Using this novel dataset, we determined that increased ANPD strongly decreased the odds of death and major injury over minor injury. Thus, the number of persons living in a household should be considered when targeting vulnerable children and youth for residential fire prevention and safety promotion programs.
BACKGROUND The Canadian Social Pediatric Interest Group has developed emerging research partnerships over the past decade. In this multi-centre partnership, we characterize social paediatrics programs (SPPs) in three dimensions: 1) fostering health equity; 2) inter-professional integration, and 3) community embeddedness, all of which involve independently complex sets of interventions. The aim of the RICHER (responsive, interdisciplinary, community health, education and research) SPP is to provide timely access to prevention and intervention services for children and youth at higher risk due to multiple social determinants of health(SDoH) including adverse childhood experiences (ACEs) and material and social poverty. OBJECTIVES Our objectives are to 1) translate SPP knowledge and experience into policy and practice through formal literature reviews and mixed methods research, 2) further develop and integrate SPPs quality improvement(QI) and research, and 3) integrate trauma informed ACE research findings into primary care and paediatric practices in Canada. DESIGN/METHODS Following established realist synthesis methodology, built on earlier mixed methods research, a literature review was undertaken to identify key mechanisms linking context/environment to health outcomes. The study method included: (1) identifying the review question, (2) formulating the initial theory, (3) searching for primary studies, (4) selecting and appraising study quality, (5) extracting, analyzing and synthesizing relevant data, and (6) refining the theory. Using mixed methods approaches, the RICHER SPP research data was analyzed to identify outcomes, develop and update logic models. Health professional survey of paediatric specialists and surgeons has been developed to explore knowledge of ACEs and SDoH and how these impact practice. RESULTS Analyses of the literature for the realist synthesis resulted in semi-predictable patterns where outcomes could be linked to activities through mechanisms. Key mechanisms were 1) willingness to share power, 2) bridging trust and relationships 3) inter-professional knowledge support and 4) family/ community empowerment. Key features of RICHER SPPs included trust, equity and partnerships, leading to parental and community engagement, improved access to services and enriched environments. There was a measured ‘critical difference’ in vulnerability on the HELP Early Developmental Index (EDI) during the study period. An approach to integrating and evaluating ACEs in different SPP practice settings has been initiated through research and QI projects. CONCLUSION Our realist synthesis identified processes of care that were effective in improving health and developmental outcomes for children and youth with adverse social and material circumstances. ‘RICHER’ SPPs, distributed in neighbourhood spaces, link primary and specialist care for vulnerable children and youth, improve health and developmental outcomes and foster equitable access to health care and transition services. These approaches may be translated into other contexts to improve access for more socially vulnerable children and youth and better integrate our knowledge of ACES into paediatric and youth health practices.
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